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FROM THE FIELD

A Midnight Emergency
10 Aug 2009 14:58:00 GMT
 Source: Medair - Switzerland
Medair

Website: Website: http://www.medair.org

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Women outside the Medair Clinic in West Darfur
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Women outside the Medair Clinic in West Darfur
Sudan (Northern States) - In conflict-affected West Darfur, the presence of Medair-supported midwives is making a life-saving difference for pregnant women and newborn children.

Background

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On a hot night in May, Aziza showed up at Medair's antenatal care (ANC) centre in Sisi, a displaced-persons camp 40 kilometres from the state capital, El Geneina, in West Darfur. She had been in labour at home for nine hours, under the care of a traditional birth attendant (TBA). The midwife on the night shift, Nour, immediately knew that this young mother was in danger.

The maternal mortality rate in Sudan is 450 deaths per 100,000 births1, which is very high compared with most Western countries (fewer than 10 per 100,000). Health experts agree that the presence at every birth of a skilled attendant-at a minimum having midwifery skills-is the best way to drastically reduce such heartbreaking and preventable loss of life.

Weeks earlier, Aziza had visited the ANC centre in Sisi, and had been strongly advised by the midwives to travel to the El Geneina hospital for her baby's delivery, based on complications with her first pregnancy that had required a Caesarean section (C-section).

"Medair's training enables midwives to identify early which women should be referred to hospital for potentially life-saving obstetric care," says Emily Chambers, Medair's Health Coordinator in West Darfur.

At First, Aziza Stays Home However, Aziza chose to remain at home for the birth, and a life-and-death crisis had arisen. She urgently needed to be seen at the El Geneina hospital for an emergency C-section.

"There are many reasons why a pregnant woman might choose to stay at home for the birth," explains Emily. "Family reasons, financial reasons, insecurity on the road, and poor advice from a trusted TBA could all contribute to this kind of decision, even though it is far safer for the woman to deliver in a proper ANC centre."

"In rural areas, women have always had delivery from TBAs," adds Margaret Poni Thomas, Medair's Midwife Supervisor in West Darfur. "Women used to think that midwives would cut them open, using episiotomy. The reality is that delivery at home is a big risk. I try to train the TBAs to understand the possible complications, so that they will refer women to a clinic."

Medair addresses the need for such social and behavioural change in West Darfur by working not only with midwives, the State Ministry of Health, and community members, but also with the TBAs themselves, training them to promote healthier behaviour and encouraging them to refer women to skilled midwives for the birth.

The Value of Skilled Midwives However, supporting the training of skilled midwives is Medair's key safe motherhood intervention in West Darfur, which is conducted in partnership with the State Ministry of Health.

"What Medair provides is continuing education for midwives, with the goal of improving their skills so that every clinic offers the minimal initial services package of reproductive health services, which includes antenatal care, safe delivery packs, safe delivery areas, contraception, post-rape treatment, Sexually Transmitted Disease treatment, and postnatal care," says Emily.

As a result, skilled midwives are now present at 18 clinics in the Medair project area, and last year, they attended over 6,700 births. Their presence at those births means that women have access to a clean delivery bed, sterile equipment, and a midwife with training on when to refer appropriately. When necessary, midwives also accompany women in labour to a nearby hospital, just as Nour did with Aziza this past May.

Safe Delivery However, before Aziza could reach the El Geneina hospital, Medair staff needed to scramble in the middle of the night to find her transportation for the 40-kilometre trip. An NGO vehicle would have been the most comfortable and quickest option, but due to banditry on the road, it was no longer safe for NGO ambulances to operate. However, some commercial vehicles are still able to make the journey. Thankfully, a truck was found, and urgent arrangements were made to transport Aziza and Nour to the hospital. Upon arrival, a gynaecologist performed a C-section that saved the lives of Aziza and her newborn child.

Exhausted but joyful, Nour and all the Medair staff at the Sisi clinic celebrated the successful birth, and the emergency referral procedures that had made it possible.

"The maternal mortality rate we can observe in women helped by our midwives has been dramatically lower than the global Sudan rates," says Emily. "These are significant, life-saving results that demonstrate the vital impact that Medair is making for the most vulnerable people in West Darfur."

1 http://www.unicef.org/infobycountry/sudan_statistics.html

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Medair is an international non-governmental organization (NGO), based in Switzerland. It has worked in Sudan since 1995, and in West Darfur since 2001, and seeks to support local institutions and capacity wherever possible. Medair employs over 350 Sudanese staff, with nearly 90 percent of its West Darfur employees coming from that state. It currently provides access to primary health care and water and sanitation for up to 200,000 conflict-affected people in West Darfur. These activities are carried out in collaboration with Sudan's Humanitarian Aid Commission, State Ministry of Health, and other government agencies; with United Nations (UN) agencies; and with other NGOs. Financial donors include the government of Switzerland (SDC) and the UN Sudan Common Humanitarian Fund, as well as other bilateral agencies.

Elsewhere in Sudan, Medair supports access to safe water and sanitation and promotes public and reproductive health in South Kordofan. In Southern Sudan, Medair provides emergency medical and water assistance during outbreaks, major movements of people, and in nutritional emergencies in a number of locations across the region, as well as improving access to primary health care and safe water sources in Upper Nile.




[ Any views expressed in this article are those of the writer and not of Reuters. ]

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[ Any views expressed in this article are those of the writer and not of Reuters. ]

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Last updated:Mon Aug 10 15:14:08 2009